A case report of plasmapheresis in the treatment of acute disseminated encephalomyelitis.
Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system associated with significant morbidity and mortality. High-dose corticosteroid administration has been considered the mainstay of treatment for ADEM; however, some patients with ADEM are refractory to steroid therapy. We report a case of a 17-year-old man suffering from ADEM who did not respond to corticosteroid therapy, but who exhibited a dramatic recovery with plasmapheresis. He became comatose, requiring ventilatory support, and exhibited abnormalities of some brainstem reflexes prior to treatment. He underwent sequential courses of plasma exchange therapy for three days. Plasma exchanges were carried out with concomitant continuous hemodiafiltration (CHDF) to control intracranial pressure by stabilizing pH, plasma Na+ concentration, and colloid osmotic pressure. After plasma exchanges, his reflexes and level of consciousness gradually improved. Eleven months after this treatment, he had only minimal neurological deficit that did not interfere with any of his activities of daily living. The efficacy of plasmapheresis for ADEM has not yet been established. Plasmapheresis may be indicated for ADEM, not only for patients with severe disease in whom high-dose corticosteroid treatment has failed, but also as first-line treatment for ADEM. Early initiation of plasmapheresis appears to be associated with moderate to marked improvement. Early recognition and early treatment of ADEM are thus of paramount importance.
Shinozaki
Koichiro
K
Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan. shino@gk9.so-net.ne.jp
Oda
Shigeto
S
Sadahiro
Tomohito
T
Nakamura
Masataka
M
Abe
Ryuzo
R
Nakamura
Shiho
S
Hattori
Noriyuki
N
Hirano
Shigeki
S
Hattori
Takamichi
T
Hirasawa
Hiroyuki
H
D000293:Adolescent; D001774:Blood Chemical Analysis; D003422:Critical Care / Q000379:methods; D004673:Encephalomyelitis, Acute Disseminated / Q000175:diagnosis* / Q000628:therapy*; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006440:Hemofiltration / Q000379:methods; D006801:Humans; D007362:Intensive Care Units; D008279:Magnetic Resonance Imaging; D008297:Male; D010956:Plasmapheresis / Q000379:methods*; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome